Open AccessResponse to Pulsed and Continuous Radiofrequency Lesioning of the Dorsal Root Ganglion and Segmental Nerves in Patients with Chronic Lumbar Radicular Pain
Author(s) -
Thomas Simopoulos
Publication year - 2008
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2008/11/137
Subject(s) - pulsed radiofrequency , medicine , radicular pain , lumbosacral joint , dorsal root ganglion , anesthesia , lumbar , surgery , analgesic , ganglion , dorsum , anatomy , pain relief
Objectives: We aimed to prospectively evaluate the response and safety ofpulsed and continuous radiofrequecy lesioning of the dorsal root ganglion/segmental nerves in patients with chronic lumbosacral radicular pain.Methods: Seventy-six patients with chronic lumbosacral radicular pain refractory to conventional therapy met the inclusion criteria and were randomly assigned to one of 2 types of treatment, pulsed radiofrequency lesioning of thedorsal root ganglion/segmental nerve or pulsed radiofrequency followed immediately by continuous radiofrequency. Patients were carefully evaluated for neurologic deficits and side effects. The response was evaluated at 2 months andwas then tracked monthly. A Kaplan-Meier analysis was used to illustrate theprobability of success over time and a Box-Whisker analysis was applied to determine the mean duration of a successful analgesic effect.Results: Two months after undergoing radiofrequency treatment, 70% of thepatients treated with pulsed radiofrequency and 82% treated with pulsed andcontinuous radiofrequency had a successful reduction in pain intensity. The average duration of successful analgesic response was 3.18 months (± 2.81) inthe group treated with pulsed radiofrequency and 4.39 months (±3.50) in thosepatients treated with pulsed and continuous radiofrequency lesioning. A Kaplan-Meier analysis illustrated that in both treatment groups the chance of success approached 50% in each group at 3 months. The vast majority of patientshad lost any beneficial effects by 8 months. There was no statistical differencebetween the 2 treatment groups. No side effects or neurological deficits werefound in either group.Conclusion: Pulsed mode radiofrequency of the dorsal root ganglion of segmental nerves appears to be a safe treatment for chronic lumbosacral radicularpain. A significant number of patients can derive at least a short-term benefit.The addition of heat via continuous radiofrequency does not offer a significantadvantage. A randomized controlled trial is now required to determine the effectiveness of pulsed radiofrequency.Key words: Pulsed radiofrequency lesioning, dorsal root ganglion, segmentalnerve, continuous radiofrequency lesioning, chronic lumbosacral radicular pain